Northwest Missouri State University APPLICATION FOR STUDENT EMPLOYMENT – GENERAL Departments of Art and Music – Fine Arts Building 101 Return this application to: Fine Arts Office, DeLuce Fine Arts Building (room 101), or e-mail to email@example.com Date of Application: Incomplete applications will NOT be considered. Date Available To Begin Work: Personal Data: (please print) Name: 919# (Last) (First) (Nickname) (Middle) Local/Campus Address: (Street) (City) (State) (Zip) Permanent Address: (Street) (City) (State) (Zip) Local/Cell Phone: Permanent Phone: University E-mail (S#): Have you ever worked for the University before? If so, what was your job title, where, and when: List any relatives presently employed by Northwest: You may work no more than a total of 20 hours per week with all campus jobs through the NW Student Employment Program. You MUST be enrolled in six (6) hours or more of academic credit each trimester that you work. Graduate students who have received assistantships are not eligible for other NW student employment positions. Which department are you applying to for a job: Art Music Have you received Federal Work-Study? Yes No What position(s) are you applying for (be specific): Hours available to work per week: Which trimesters are you available to work? Fall Spring Summer Education: Class: Freshman Sophomore Junior Senior Graduate NW GPA: Course of Study (major/minor): Date of NW Graduation (sem/year): Skills: Describe your academic and work-related experiences as well as other employment skills in further detail which qualify you for the position(s) for which you are applying: Hobbies: Campus honors, activities, and organization memberships: Do you anticipate involvement in any other activities (i.e. organizations, sports, rehearsals, educational observations, practicums, student ambassadorships, other employment, etc.) that might conflict with your work schedule? If yes, please explain: Employment History: (list most recent position first) 1. Employer: Dates of Employment: Type of Business: Supervisor’s Name: City and State: Phone: Job Title and Duties: Reason for Leaving: 2. Employer: Dates of Employment: Type of Business: Supervisor’s Name: City and State: Phone: Job Title and Duties: Reason for Leaving: Schedule: Please fill in your class schedule below (include all classes, other employment, activities, etc.) You may indicate any special preference for working hours as desired. Monday Tuesday Wednesday Thursday Friday 8:00 9:00 10:00 11:00 12:00 1:00 2:00 3:00 4:00 Evenings 5:00 pm 6:00 pm 7:00 pm 8:00 pm Are you available: Saturday afternoon Saturday evening Sunday afternoon Sunday evening PLEASE READ CAREFULLY - By inserting my name (as written above) in the text field below, I certify that the above statements are correct. I understand that any false information (or omissions) in the application, or its supporting documents, will be sufficient grounds for refusal to hire me or termination without notice. I agree that all rules, orders, and regulations of the Board of Regents affecting my employment shall constitute a part of my appointment or employment. I further understand that Northwest Missouri State University has the right to review my education, previous employment, driving and criminal records and other background data. Please re-type your name here (this is a proxy for your signature): Date (MM/DD/YYYY): Northwest Missouri State University is an equal opportunity employer.
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